Impact of Spinal Alignment on Pelvic Floor Efficiency

The purpose of this study was to determine the effect of spinal alignment on pelvic floor efficiency in nulliparous women.

Study Overview

• Status: Completed
• Conditions: Pelvic Floor Disorders; Spinal Deformity
• Intervention / Treatment: Other: No Intervention

Detailed Description

Pelvic floor dysfunction (PFD) may extend beyond the pelvic region by inducing myofascial disturbances in anatomically distant structures connected through the myofascial network. Among these, low back pain (LBP) is one of the most frequently reported musculoskeletal conditions associated with PFD. This relationship is thought to arise from lumbopelvic instability and altered coordination of the core musculature. The pelvic floor muscles (PFMs), together with the transversus abdominis, diaphragm, and multifidus, form an integrated stabilizing system that contributes to spinal stability and postural control. Consequently, dysfunction of the transversus abdominis may compromise not only pelvic floor function but also overall lumbopelvic stability. Women with LBP have been shown to exhibit reduced PFM contraction strength despite preserved transversus abdominis activation, suggesting that impaired PFM function may play a more prominent role in the development of LBP than deficits in the abdominal muscles alone. Conversely, inadequate activation or endurance of the transversus abdominis has also been associated with impaired PFM function. Furthermore, altered movement patterns, dysfunctional breathing, and postural deviations can disrupt load transfer through the lumbopelvic region, thereby increasing the risk of PFD.

There is a dearth of knowledge regarding the effect of spinal alignment on pelvic floor efficiency in nulliparous women. This study, therefore, contributes valuable insights into a relatively unexplored area of nulliparous women's health. By assessing the pelvic floor muscles in nulliparous women with different spinal alignment patterns, including lordosis, kyphosis, and scoliosis, this study may enhance the well-being of nulliparous women, provide a more comprehensive approach to health improvement, help protect them from future pelvic floor dysfunction, and broaden the scope of physiotherapy in women's health.

• Study Type: Observational
• Enrollment (Actual): 80

Contacts and Locations

Study Locations

• Egypt
  • Giza, Egypt
    • Faculty of physical therapy, Cairo University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

The study population consisted of 80 nulliparous women aged 25-35 years with different spinal alignment patterns (thoracolumbar scoliosis, hyperlordosis, thoracic kyphosis, or normal spinal alignment). Participants were recruited from the outpatient orthopedic clinic of Gesr El Suez, Cairo, Egypt. Eligible participants had a body mass index (BMI) of <30 kg/m² and no history of pregnancy, spinal surgery, congenital spinal deformity, neuromuscular disorders, systemic diseases, malignancy, or urogenital disorders.

Description

Inclusion Criteria:

• Nulliparous women.
• Their ages will range from 25 to 35 years old.
• Their body mass index (BMI) will not exceed 29.9 Kg/m2.

Exclusion Criteria:

• Female with congenital spinal deformity.
• Female with a history of neuromuscular disease.
• Female Diagnosed with any systemic disease .
• Female with a history of malignancy and/or ongoing treatment.
• Female with a history of urogenital diseases and surgical history.
• Female with previous spinal surgery.
• Female with previous pregnancy .

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Nulliparous women with thoracolumbar scoliosis; Twenty nulliparous women with thoracolumbar scoliosis. They will undergo assessment using Formetric analysis and vaginal pressure biofeedback.	Other: No Intervention; No Intervention
Nulliparous women with hyperlordosis; Twenty nulliparous women with hyperlordosis. They will undergo assessment using Formetric analysis and vaginal pressure biofeedback.	Other: No Intervention; No Intervention
Nulliparous women with thoracic kyphosis; Twenty nulliparous women with thoracic kyphosis. They will undergo assessment using Formetric analysis and vaginal pressure biofeedback.	Other: No Intervention; No Intervention
Nulliparous women with normal spinal alignment; Twenty nulliparous women with normal spinal alignment. They will undergo assessment using Formetric analysis and vaginal pressure biofeedback.	Other: No Intervention; No Intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pelvic floor muscle strength	Pelvic floor muscle strength was measured using vaginal pressure biofeedback (maximum voluntary contraction pressure).	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pelvic floor muscle endurance	Pelvic floor muscle endurance was assessed using vaginal pressure biofeedback (duration of sustained maximal voluntary contraction).	Baseline
Spinal alignment angle	It was measured using the DIERS Formetric 4D system.	Baseline
Pelvic floor dysfunction symptoms	Total score and domain scores (bladder, bowel, prolapse, and sexual function) were assessed using the Australian Pelvic Floor Questionnaire (APFQ).	Baseline
Health-related quality of life	It was assessed by using Free online SF-12 Health Survey Version 2 (SF-12v2) score calculator. The SF-12V2 measures eight scales: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health.	Baseline

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Chair: Afaf Mohamed Mahmoud Botla, PhD, Professor, Cairo University; Study Director: Amira Nagy Abd Ellatief Hamad, PhD, Lecturer, Cairo University; Study Director: Amal Abd Elrahman Mohamed Elborady, Assist. Professor, Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2024
• Primary Completion (Actual): August 31, 2025
• Study Completion (Actual): August 31, 2025

Study Registration Dates

• First Submitted: July 3, 2026
• First Submitted That Met QC Criteria: July 3, 2026
• First Posted (Actual): July 9, 2026

Study Record Updates

• Last Update Posted (Actual): July 9, 2026
• Last Update Submitted That Met QC Criteria: July 3, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Male Urogenital Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Pelvic Floor Disorders
• Other Study ID Numbers: P.T.REC/012/005314

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No